Nervous System: Cns Tumors

Front 1

What is the defining characteristic that differentiates a Glioblastoma from an anaplastic astrocytoma?

Back 1

Necrosis (serpentine pseudopallisading)

Vascular Proliferation

Front 2

what is the frequency of brain tumors in the US? And what percentage are primary?

Back 2

1-7/10,000
1/2-3/4 are primary mets

Front 3

what are the four major classes of intracranial tumors?

Back 3

1) Gliomas
2) Neuronal Tumors
3) Poorly differentiated neoplasms
4) Meningiomas

Front 4

what are the three factors a physcian must consider when diagnosing brain tumors?

Back 4

Location, Age of Patient, Imaging Characteristics

Front 5

what is the most common form of glioma? ~80%

Back 5

fibrillary astrocytoma

Front 6

at what age are fibrillary astrocytomas usually found?

Back 6

40-60

Front 7

what do fibrillary astrocytomas look like microscopically and marcro?

Back 7

marco: is grey infiltrative, and distorts the brain

micro: increase in the number of glial cell nuclei, variable pleomorphism, and GFAP+ (which are astrcytic cell processes which give a fibrillary background appearance.

Front 8

what do anaplastic astrocytomas look like micro and macro?

Back 8

and more densely cellular, greater nuclear pleomorphism and mitotically active cells

Front 9

what is characteristic of an astrocytoma WHO grade 2

Back 9

it does not show mitosis or necrosis but you will see the fibrillary appearance

Front 10

what is the factor that is thought to be contributing to the vascular proliferation in Glioblastomas?

Back 10

VEGF which is vascular endothelial cell growth factor...possible as a result from hypoxia

Front 11

it is showing necrosis and diasnostic of glioblastoma...only glioblastoma has necrosis

Back 11

what is this photo showing and why is this diagnostic?

Front 12

poorly differentiated cells which are huge tumor cells

Back 12

what should you take note about this picture of glioblastoma?

Front 13

what age group are pilocytic astrocytomas found? and where?

Back 13

children?
usually in the cerebellum

Front 14

what appearance is commonly found in pilocytic astrocytoma

Back 14

1) cystic mass with enhancing mural nodule
2) bipolar cells with long thin "hairlike" GFAP+ projections
3) ROSENTHAL FIBERS

Front 15

When are brainstem tumors usually formed?

Back 15

0-20 Y.O.

Front 16

which brainstem gliomas are most common, aggressive and have a short survival?

Back 16

pontine gliomas

Front 17

which age group are oligodendrogliomas common? and where are they usually found?

Back 17

40-50 Y.O.
cerebral hemispheres

Front 18

A WHO grade 2 oligodendroglioma will usually have what appearance?

Back 18

1) delicate netwoek of anastomosing capillaries
2) calficication
3) LITTLE MITOTIC activity

Front 19

what is characteristic of rosenthal fibers?

Back 19

is a thick, elongated, worm-like eosinophilic (pink) bundle that is found on H&E staining of the brain in the presence of long standing gliosis

Front 20

what is the difference between grade 3 and 2 oligodendrogliomas?

Back 20

grade three has mitotic activity, increased cell density, nuclear anaplasia, and NECROSIS.

Front 21

which has a better prognosis, astrocytomas or oligodendrogliomas?

Back 21

oligo

Front 22

what age group and where are ependymomas found?

Back 22

0-20 Y.O.
found in the 4th ventricle
in adults the central canal of the spinal cord is most commonly effected (NF II)

Front 23

why is resection of the epydymoma difficult or not possible?

Back 23

b/c of their relation to the medullo/pontine nuclei

Front 24

what do the tumor cells sometimes form in ependymomas?

Back 24

rosettes
perivascular pseudorossetes=these are tumor cells surrounding vessels with an intervening zone made up of thin ependymal processes directed toward the wall

Front 25

what do the different rosettes look like?

Back 25

like this bitch

Front 26

what genetic disorder is spinal cord ependymomas associated with? and where are these tumors found (called what)?

Back 26

neurofibromatosis 2
filum terminale called myxopapillary ependymoma

Front 27

what tumor is commonly found in children in their lateral ventricals or found in the 4th ventrical in adults which results in hydrocephalus to due to obstruction of ventriuclar system

Back 27

choroid plexus papilloma

Front 28

what are neuronal tumors that are made up of entirely ganglion cells?

Back 28

gangliocytoma

Front 29

what is the typical features of gangliocytoma?

Back 29

neoplastic ganglion cells are present as clumps of cells separated by relatively ACELLULAR STROMA

Front 30

what neuronal tumors have a cyctic component, irregularly clustered and have random orientation of neurites?

Back 30

gangliogliomas

Front 31

dysembryoplastic neuroepithlial tumors usually present how?age?

Back 31

childhood, seizures, growth in superficial temporal lobe, and a good prognosis

Front 32

what are the typical features of the dysembroplastic neuroepithlial tumors?

Back 32

1) blue/small cells
2) glial-neuronal element
3) multiple intacortical nodules with a myxoid background
4) "floating neurons" of the myxoid background

Front 33

the most common malignant CNS tumor in children is?

Back 33

medulloblastoma

Front 34

where do medulloblatomas usually form?

Back 34

inferior vermis

Front 35

what should you see with medulloblastomas if they are neuroepithelial?

Back 35

small/blue cells

Front 36

what rosettes may be found in medulloblastomas

Back 36

homer-wright

Front 37

what tumor is a grade 4 and involves small round blue cells tumors/commonly presented in young children and infants

Back 37

PNET-primitive neuroectodermal tumor

Front 38

what age group does Atypical teratoid/rhabdoid tumor present in?

Back 38

usually under 5

Front 39

what is the typical micro morphology of an AT/RT...where are they commonly presented?

Back 39

rhabdoid cells with eosinophilic cytoplasm and eccentric nuclei
abundant mitosis
grade 4
commonly found in the cerebellum/ or posteroir cerebrum

Front 40

what is the most common CNS neoplasm in immunosuppressed patients such as AIDS patients?

Back 40

primary CNS lymphomas

Front 41

The malignant lymphoma cells infiltrate the brain parenchyma and accumulate around blood vessels

Back 41

yes

Front 42

where are germ cell tumors such as germinoma in the CNS commonly found?

Back 42

midline almost always around the 3rd ventrical
and pineal region

Front 43

what is seen in teratomas?
what nationality has a strong relation to teratomas?

Back 43

these are the crazy looking tumors with hair and teeth..they usually present with hydrocephalus, visual problems, pituitary failure or precocious puberty
japanese

Front 44

what tumors are described as rounded masses with a well defined dural bas and compresses the underlying brain with possible focal deficits?

Back 44

meingioma=mainly benign

Front 45

the mass of meningiomas may be polypoid (sheet like tumor spread along the surface of dura which is associated with hyperostotic reactive changes in overlying bone with what kind of bodies?

Back 45

psammoma bodies

Front 46

a histological pattern of meningiomas is described as whorled clusters of cells which sit in groups without a visible cell membrane...what is this pattern called?

Back 46

syntial

Front 47

what histological pattern is described as forming from calcification of syncytial nests of meningothelial cells?

Back 47

psammomatous bodies

Front 48

what is the criteria for a grade 2 atypical meningioma?

Back 48

-greater then 4 mitoses/10power
OR (3 or more atypical things)
1) increased cellularity
2) small cells with high nuclear/cytoplasmic ratio
3) patternless growth
4) necrosis
5) prominent nucleoli

Front 49

how many mitosis/10power field is considered the anaplastic meningioma?

Back 49

20/hpf

Front 50

what are the most common metastatic tumors to the brain? 5 are included

Back 50

lung, breast, kidney, GI, skin (melanoma)

Front 51

which tumors have micro patterns of "nuclear free zones" that lie between areas of nuclear palisading called VEROCAY BODIES?

Back 51

Peripheral Nerve Sheath Tumors: Antoni A pattern

Front 52

which nerve are peripheral nerve sheath tumors attached to if they occur in the cranium?

Back 52

vestibular branch of 8th CN..called an acoustic neuroma

Front 53

what pattern in peripheral nerve sheath tumors is considered less dense cellular areas with loose meshwork of cells with microcyts and myxoid changes?

Back 53

Antoni B

Front 54

neurofibromas are usually formed with what genetic disorder?

Back 54

neurofibromatosis type 1

Front 55

what is the difference between a schwannoma and the neurofibroma?

Back 55

you can not seperate the lesion from the nerve in with a neurofibroma. there are fingers of the tumor that insert themselves into the nerve fibers

Front 56

in neurofibromatosis type 1 which kind of tumor is likely to undergo malignant degeration at a higher rate then in the general population?

Back 56

plexiform type neurofibromas

Front 57

what are the common tumors seen in neurofibromatosis type 2

Back 57

bilateral VIII nerve schwannoma and multiple meningiomas, and ependymomas of the spinal cord

Front 58

what is the triad of tuberous sclerosis? In addition with hamartomas and other benign neoplasms

Back 58

mental retardation
seizures
adenoma sebaceum (facial rash)

Front 59

what astrocytomas are unique to tuberous sclerosis and are a WHO grade 1 but they may obstruct CSF of the ventricles?

Back 59

SEGA: subependymal giant cell astrocytoma

Front 60

what are the microscopic features of oligoddendrogliomas?

Back 60

halo surronding the nuclei (fried egg cells)
anastomosing capillaries (chicken wire fencing)
90% show calcification